|
REPAIR TRUNK 2.6 TO 7.5 CM(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
761P0150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$498.30 |
| Rate for Payer: Aetna Commercial |
$404.90
|
| Rate for Payer: Ambetter Exchange |
$229.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$125.45
|
| Rate for Payer: Anthem Medicaid |
$174.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.80
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$498.30
|
| Rate for Payer: Healthspan PPO |
$437.58
|
| Rate for Payer: Humana Medicaid |
$174.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$356.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.94
|
| Rate for Payer: Molina Healthcare Passport |
$174.45
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$298.78
|
| Rate for Payer: UHCCP Medicaid |
$131.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.83
|
|
|
REPAIR TRUNK 2.6 TO 7.5 CM(T
|
Facility
|
IP
|
$2,601.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
761T0150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.30 |
| Max. Negotiated Rate |
$2,496.96 |
| Rate for Payer: Aetna Commercial |
$2,002.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.78
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,158.83
|
| Rate for Payer: First Health Commercial |
$2,470.95
|
| Rate for Payer: Humana Commercial |
$2,210.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,919.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.69
|
| Rate for Payer: PHCS Commercial |
$2,496.96
|
| Rate for Payer: United Healthcare All Payer |
$2,288.88
|
|
|
REPAIR TRUNK 2.6 TO 7.5 CM(T
|
Facility
|
OP
|
$2,601.00
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
761T0150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,496.96 |
| Rate for Payer: Aetna Commercial |
$2,002.77
|
| Rate for Payer: Anthem Medicaid |
$894.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cash Price |
$1,300.50
|
| Rate for Payer: Cigna Commercial |
$2,158.83
|
| Rate for Payer: First Health Commercial |
$2,470.95
|
| Rate for Payer: Humana Commercial |
$2,210.85
|
| Rate for Payer: Humana KY Medicaid |
$894.48
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$903.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,919.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.69
|
| Rate for Payer: PHCS Commercial |
$2,496.96
|
| Rate for Payer: United Healthcare All Payer |
$2,288.88
|
|
|
REPAIR TUNNELED CV CATH
|
Professional
|
Both
|
$4,562.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
76101482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$2,737.20 |
| Rate for Payer: Aetna Commercial |
$288.76
|
| Rate for Payer: Ambetter Exchange |
$171.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.13
|
| Rate for Payer: Anthem Medicaid |
$305.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.30
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$278.44
|
| Rate for Payer: Healthspan PPO |
$422.18
|
| Rate for Payer: Humana Medicaid |
$305.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.27
|
| Rate for Payer: Molina Healthcare Passport |
$305.17
|
| Rate for Payer: Multiplan PHCS |
$2,737.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.40
|
| Rate for Payer: UHCCP Medicaid |
$98.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.08
|
|
|
REPAIR TUNNELED CV CATH
|
Facility
|
IP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
76101482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.60 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,968.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,147.78
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
REPAIR TUNNELED CV CATH
|
Facility
|
OP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
76101482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem Medicaid |
$1,568.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Humana KY Medicaid |
$1,568.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,584.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,968.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,147.78
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
REPAIR TUNNELED CV CATH(P
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
761P1482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$422.18 |
| Rate for Payer: Aetna Commercial |
$288.76
|
| Rate for Payer: Ambetter Exchange |
$171.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.13
|
| Rate for Payer: Anthem Medicaid |
$305.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.30
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna Commercial |
$278.44
|
| Rate for Payer: Healthspan PPO |
$422.18
|
| Rate for Payer: Humana Medicaid |
$305.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$311.27
|
| Rate for Payer: Molina Healthcare Passport |
$305.17
|
| Rate for Payer: Multiplan PHCS |
$231.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.40
|
| Rate for Payer: UHCCP Medicaid |
$98.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.08
|
|
|
REPAIR TUNNELED CV CATH(T
|
Facility
|
OP
|
$4,177.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
761T1482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$4,009.92 |
| Rate for Payer: Aetna Commercial |
$3,216.29
|
| Rate for Payer: Anthem Medicaid |
$1,436.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,258.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$2,088.50
|
| Rate for Payer: Cash Price |
$2,088.50
|
| Rate for Payer: Cigna Commercial |
$3,466.91
|
| Rate for Payer: First Health Commercial |
$3,968.15
|
| Rate for Payer: Humana Commercial |
$3,550.45
|
| Rate for Payer: Humana KY Medicaid |
$1,436.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,451.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,425.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,633.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.13
|
| Rate for Payer: PHCS Commercial |
$4,009.92
|
| Rate for Payer: United Healthcare All Payer |
$3,675.76
|
|
|
REPAIR TUNNELED CV CATH(T
|
Facility
|
IP
|
$4,177.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
761T1482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,253.10 |
| Max. Negotiated Rate |
$4,009.92 |
| Rate for Payer: Aetna Commercial |
$3,216.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,258.06
|
| Rate for Payer: Cash Price |
$2,088.50
|
| Rate for Payer: Cigna Commercial |
$3,466.91
|
| Rate for Payer: First Health Commercial |
$3,968.15
|
| Rate for Payer: Humana Commercial |
$3,550.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,425.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,082.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,675.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,633.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.13
|
| Rate for Payer: PHCS Commercial |
$4,009.92
|
| Rate for Payer: United Healthcare All Payer |
$3,675.76
|
|
|
REPAIR WEBBED TOE(S)
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 28345
|
| Hospital Charge Code |
76102958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.91 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REPAIR WEBBED TOE(S)
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 28345
|
| Hospital Charge Code |
76102958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REPAIR WEBBED TOE(S)
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 28345
|
| Hospital Charge Code |
76102958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.03 |
| Max. Negotiated Rate |
$720.11 |
| Rate for Payer: Aetna Commercial |
$622.14
|
| Rate for Payer: Ambetter Exchange |
$344.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$197.03
|
| Rate for Payer: Anthem Medicaid |
$322.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$413.80
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$690.83
|
| Rate for Payer: Healthspan PPO |
$720.11
|
| Rate for Payer: Humana Medicaid |
$322.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.40
|
| Rate for Payer: Molina Healthcare Passport |
$322.94
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.28
|
| Rate for Payer: UHCCP Medicaid |
$206.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.83
|
|
|
REPAIR WINDPIPE OPENING
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 31614
|
| Hospital Charge Code |
41000034
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$377.81 |
| Max. Negotiated Rate |
$1,117.32 |
| Rate for Payer: Aetna Commercial |
$1,117.32
|
| Rate for Payer: Ambetter Exchange |
$660.62
|
| Rate for Payer: Anthem Medicaid |
$377.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$660.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$792.74
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$990.99
|
| Rate for Payer: Healthspan PPO |
$872.37
|
| Rate for Payer: Humana Medicaid |
$377.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$660.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.37
|
| Rate for Payer: Molina Healthcare Passport |
$377.81
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$858.81
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$660.62
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 31614
|
| Hospital Charge Code |
41000034
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPAIR WINDPIPE OPENING
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 31614
|
| Hospital Charge Code |
41000034
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPAIR WINDPIPE OPENING(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 31614
|
| Hospital Charge Code |
410P0034
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$377.81 |
| Max. Negotiated Rate |
$1,117.32 |
| Rate for Payer: Aetna Commercial |
$1,117.32
|
| Rate for Payer: Ambetter Exchange |
$660.62
|
| Rate for Payer: Anthem Medicaid |
$377.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$660.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$792.74
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$990.99
|
| Rate for Payer: Healthspan PPO |
$872.37
|
| Rate for Payer: Humana Medicaid |
$377.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$660.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.37
|
| Rate for Payer: Molina Healthcare Passport |
$377.81
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$858.81
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$660.62
|
|
|
REPAIR WOUND 7.6-12.5
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
76100136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Ambetter Exchange |
$192.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.82
|
| Rate for Payer: Anthem Medicaid |
$127.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.99
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$365.25
|
| Rate for Payer: Healthspan PPO |
$330.53
|
| Rate for Payer: Humana Medicaid |
$127.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$254.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.84
|
| Rate for Payer: Molina Healthcare Passport |
$127.29
|
| Rate for Payer: Multiplan PHCS |
$558.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$250.24
|
| Rate for Payer: UHCCP Medicaid |
$109.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.49
|
|
|
REPAIR WOUND 7.6-12.5
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
45000057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPAIR WOUND 7.6-12.5
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
76100136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.39
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
REPAIR WOUND 7.6-12.5
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
76100136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.17 |
| Max. Negotiated Rate |
$893.76 |
| Rate for Payer: Aetna Commercial |
$716.87
|
| Rate for Payer: Anthem Medicaid |
$320.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: Cigna Commercial |
$772.73
|
| Rate for Payer: First Health Commercial |
$884.45
|
| Rate for Payer: Humana Commercial |
$791.35
|
| Rate for Payer: Humana KY Medicaid |
$320.17
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$323.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$763.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$819.28
|
| Rate for Payer: Ohio Health Group HMO |
$698.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.39
|
| Rate for Payer: PHCS Commercial |
$893.76
|
| Rate for Payer: United Healthcare All Payer |
$819.28
|
|
|
REPAIR WOUND 7.6-12.5
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
45000057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPAIR WOUND 7.6-12.5(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
761P0136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.82 |
| Max. Negotiated Rate |
$365.25 |
| Rate for Payer: Aetna Commercial |
$288.68
|
| Rate for Payer: Ambetter Exchange |
$192.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.82
|
| Rate for Payer: Anthem Medicaid |
$127.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$192.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$230.99
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$365.25
|
| Rate for Payer: Healthspan PPO |
$330.53
|
| Rate for Payer: Humana Medicaid |
$127.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$254.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$192.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.84
|
| Rate for Payer: Molina Healthcare Passport |
$127.29
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$250.24
|
| Rate for Payer: UHCCP Medicaid |
$109.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$192.49
|
|
|
REPAIR WOUND 7.6-12.5(T
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
761T0136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPAIR WOUND 7.6-12.5(T
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
761T0136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPAIR WRIST JOINTS
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
76100615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.65 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,747.90
|
| Rate for Payer: Anthem Medicaid |
$780.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,770.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cigna Commercial |
$1,884.10
|
| Rate for Payer: First Health Commercial |
$2,156.50
|
| Rate for Payer: Humana Commercial |
$1,929.50
|
| Rate for Payer: Humana KY Medicaid |
$780.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$788.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,861.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,675.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$796.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,997.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,702.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,974.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,566.30
|
| Rate for Payer: PHCS Commercial |
$2,179.20
|
| Rate for Payer: United Healthcare All Payer |
$1,997.60
|
|
