|
REPAIR WRIST JOINTS
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
76100615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.00 |
| Max. Negotiated Rate |
$2,179.20 |
| Rate for Payer: Aetna Commercial |
$1,747.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,770.60
|
| 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: 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 |
$681.00
|
| 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
|
|
|
REPAIR WRIST JOINTS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
76100615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$586.06 |
| Max. Negotiated Rate |
$1,362.00 |
| Rate for Payer: Aetna Commercial |
$1,188.29
|
| Rate for Payer: Ambetter Exchange |
$762.32
|
| Rate for Payer: Anthem Medicaid |
$586.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$914.78
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cigna Commercial |
$1,289.15
|
| Rate for Payer: Healthspan PPO |
$1,076.34
|
| Rate for Payer: Humana Medicaid |
$586.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$762.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$597.78
|
| Rate for Payer: Molina Healthcare Passport |
$586.06
|
| Rate for Payer: Multiplan PHCS |
$1,362.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$991.02
|
| Rate for Payer: UHCCP Medicaid |
$794.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$591.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.32
|
|
|
REPAIR WRIST JOINTS(P
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 25447
|
| Hospital Charge Code |
761P0615
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$586.06 |
| Max. Negotiated Rate |
$1,362.00 |
| Rate for Payer: Aetna Commercial |
$1,188.29
|
| Rate for Payer: Ambetter Exchange |
$762.32
|
| Rate for Payer: Anthem Medicaid |
$586.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$914.78
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cash Price |
$1,135.00
|
| Rate for Payer: Cigna Commercial |
$1,289.15
|
| Rate for Payer: Healthspan PPO |
$1,076.34
|
| Rate for Payer: Humana Medicaid |
$586.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,015.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$762.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$597.78
|
| Rate for Payer: Molina Healthcare Passport |
$586.06
|
| Rate for Payer: Multiplan PHCS |
$1,362.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$991.02
|
| Rate for Payer: UHCCP Medicaid |
$794.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$591.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.32
|
|
|
REP CATH
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
76101481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.10 |
| Max. Negotiated Rate |
$1,715.52 |
| Rate for Payer: Aetna Commercial |
$1,375.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.86
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$1,483.21
|
| Rate for Payer: First Health Commercial |
$1,697.65
|
| Rate for Payer: Humana Commercial |
$1,518.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.03
|
| Rate for Payer: PHCS Commercial |
$1,715.52
|
| Rate for Payer: United Healthcare All Payer |
$1,572.56
|
|
|
REP CATH
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
76101481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,715.52 |
| Rate for Payer: Aetna Commercial |
$1,375.99
|
| Rate for Payer: Anthem Medicaid |
$614.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$1,483.21
|
| Rate for Payer: First Health Commercial |
$1,697.65
|
| Rate for Payer: Humana Commercial |
$1,518.95
|
| Rate for Payer: Humana KY Medicaid |
$614.55
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$620.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.03
|
| Rate for Payer: PHCS Commercial |
$1,715.52
|
| Rate for Payer: United Healthcare All Payer |
$1,572.56
|
|
|
REP CATH
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
76101481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$1,072.20 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Ambetter Exchange |
$31.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.68
|
| Rate for Payer: Anthem Medicaid |
$120.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.66
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cash Price |
$893.50
|
| Rate for Payer: Cigna Commercial |
$60.55
|
| Rate for Payer: Healthspan PPO |
$190.37
|
| Rate for Payer: Humana Medicaid |
$120.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.09
|
| Rate for Payer: Molina Healthcare Passport |
$120.68
|
| Rate for Payer: Multiplan PHCS |
$1,072.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.79
|
| Rate for Payer: UHCCP Medicaid |
$30.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.38
|
|
|
REP CATH(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761P1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$190.37 |
| Rate for Payer: Aetna Commercial |
$66.29
|
| Rate for Payer: Ambetter Exchange |
$31.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.68
|
| Rate for Payer: Anthem Medicaid |
$120.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.66
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$60.55
|
| Rate for Payer: Healthspan PPO |
$190.37
|
| Rate for Payer: Humana Medicaid |
$120.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.09
|
| Rate for Payer: Molina Healthcare Passport |
$120.68
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.79
|
| Rate for Payer: UHCCP Medicaid |
$30.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.38
|
|
|
REP CATH(T
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761T1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.33 |
| Max. Negotiated Rate |
$1,513.92 |
| Rate for Payer: Aetna Commercial |
$1,214.29
|
| Rate for Payer: Anthem Medicaid |
$542.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cigna Commercial |
$1,308.91
|
| Rate for Payer: First Health Commercial |
$1,498.15
|
| Rate for Payer: Humana Commercial |
$1,340.45
|
| Rate for Payer: Humana KY Medicaid |
$542.33
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$547.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$553.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.13
|
| Rate for Payer: PHCS Commercial |
$1,513.92
|
| Rate for Payer: United Healthcare All Payer |
$1,387.76
|
|
|
REP CATH(T
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
761T1481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.10 |
| Max. Negotiated Rate |
$1,513.92 |
| Rate for Payer: Aetna Commercial |
$1,214.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,230.06
|
| Rate for Payer: Cash Price |
$788.50
|
| Rate for Payer: Cigna Commercial |
$1,308.91
|
| Rate for Payer: First Health Commercial |
$1,498.15
|
| Rate for Payer: Humana Commercial |
$1,340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,293.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,163.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,387.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,371.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.13
|
| Rate for Payer: PHCS Commercial |
$1,513.92
|
| Rate for Payer: United Healthcare All Payer |
$1,387.76
|
|
|
REPLACE AORTIC VALVE
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE AORTIC VALVE
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$4,833.47 |
| Rate for Payer: Aetna Commercial |
$4,833.47
|
| Rate for Payer: Ambetter Exchange |
$2,708.20
|
| Rate for Payer: Anthem Medicaid |
$2,134.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,708.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,708.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,249.84
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,509.19
|
| Rate for Payer: Healthspan PPO |
$4,752.25
|
| Rate for Payer: Humana Medicaid |
$2,134.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,070.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,708.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,708.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,176.77
|
| Rate for Payer: Molina Healthcare Passport |
$2,134.09
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,520.66
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,155.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,708.20
|
|
|
REPLACE AORTIC VALVE
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
76101286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPLACE AORTIC VALVE(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33406
|
| Hospital Charge Code |
761P1286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,925.00 |
| Max. Negotiated Rate |
$4,833.47 |
| Rate for Payer: Aetna Commercial |
$4,833.47
|
| Rate for Payer: Ambetter Exchange |
$2,708.20
|
| Rate for Payer: Anthem Medicaid |
$2,134.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,708.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,708.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,249.84
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,509.19
|
| Rate for Payer: Healthspan PPO |
$4,752.25
|
| Rate for Payer: Humana Medicaid |
$2,134.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,070.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,708.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,708.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,176.77
|
| Rate for Payer: Molina Healthcare Passport |
$2,134.09
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,520.66
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,155.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,708.20
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.82 |
| Max. Negotiated Rate |
$23,788.86 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,992.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,788.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,939.25
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$16,992.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,390.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REPLACE ELBOW JOINT
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$2,375.72 |
| Rate for Payer: Aetna Commercial |
$2,207.39
|
| Rate for Payer: Ambetter Exchange |
$1,375.41
|
| Rate for Payer: Anthem Medicaid |
$1,225.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,375.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,650.49
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,375.72
|
| Rate for Payer: Healthspan PPO |
$1,999.42
|
| Rate for Payer: Humana Medicaid |
$1,225.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,873.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,375.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,249.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,225.00
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,788.03
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,375.41
|
|
|
REPLACE ELBOW JOINT
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
76100525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REPLACE ELBOW JOINT(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 24363
|
| Hospital Charge Code |
761P0525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$2,375.72 |
| Rate for Payer: Aetna Commercial |
$2,207.39
|
| Rate for Payer: Ambetter Exchange |
$1,375.41
|
| Rate for Payer: Anthem Medicaid |
$1,225.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,375.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,650.49
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,375.72
|
| Rate for Payer: Healthspan PPO |
$1,999.42
|
| Rate for Payer: Humana Medicaid |
$1,225.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,873.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,375.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,249.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,225.00
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,788.03
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,375.41
|
|
|
REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.15 |
| Max. Negotiated Rate |
$1,853.28 |
| Rate for Payer: Aetna Commercial |
$1,486.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.79
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$1,602.32
|
| Rate for Payer: First Health Commercial |
$1,833.97
|
| Rate for Payer: Humana Commercial |
$1,640.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.05
|
| Rate for Payer: PHCS Commercial |
$1,853.28
|
| Rate for Payer: United Healthcare All Payer |
$1,698.84
|
|
|
REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$663.90 |
| Max. Negotiated Rate |
$1,853.28 |
| Rate for Payer: Aetna Commercial |
$1,486.48
|
| Rate for Payer: Anthem Medicaid |
$663.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$1,602.32
|
| Rate for Payer: First Health Commercial |
$1,833.97
|
| Rate for Payer: Humana Commercial |
$1,640.92
|
| Rate for Payer: Humana KY Medicaid |
$663.90
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.05
|
| Rate for Payer: PHCS Commercial |
$1,853.28
|
| Rate for Payer: United Healthcare All Payer |
$1,698.84
|
|
|
REPLACE G-J TUBE PERC
|
Professional
|
Both
|
$1,930.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
76102009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$1,158.30 |
| Rate for Payer: Aetna Commercial |
$237.34
|
| Rate for Payer: Ambetter Exchange |
$127.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.43
|
| Rate for Payer: Anthem Medicaid |
$787.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.70
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna Commercial |
$214.13
|
| Rate for Payer: Healthspan PPO |
$1,080.30
|
| Rate for Payer: Humana Medicaid |
$787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$803.49
|
| Rate for Payer: Molina Healthcare Passport |
$787.74
|
| Rate for Payer: Multiplan PHCS |
$1,158.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.43
|
| Rate for Payer: UHCCP Medicaid |
$140.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$795.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.25
|
|
|
REPLACE G-J TUBE PERC(P
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761P2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$1,080.30 |
| Rate for Payer: Aetna Commercial |
$237.34
|
| Rate for Payer: Ambetter Exchange |
$127.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.43
|
| Rate for Payer: Anthem Medicaid |
$787.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.70
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$214.13
|
| Rate for Payer: Healthspan PPO |
$1,080.30
|
| Rate for Payer: Humana Medicaid |
$787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$803.49
|
| Rate for Payer: Molina Healthcare Passport |
$787.74
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.43
|
| Rate for Payer: UHCCP Medicaid |
$140.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$795.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.25
|
|
|
REPLACE G-J TUBE PERC(T
|
Facility
|
IP
|
$1,590.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761T2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.15 |
| Max. Negotiated Rate |
$1,526.88 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.59
|
| Rate for Payer: Cash Price |
$795.25
|
| Rate for Payer: Cigna Commercial |
$1,320.12
|
| Rate for Payer: First Health Commercial |
$1,510.97
|
| Rate for Payer: Humana Commercial |
$1,351.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.44
|
| Rate for Payer: PHCS Commercial |
$1,526.88
|
| Rate for Payer: United Healthcare All Payer |
$1,399.64
|
|
|
REPLACE G-J TUBE PERC(T
|
Facility
|
OP
|
$1,590.50
|
|
|
Service Code
|
HCPCS 49452
|
| Hospital Charge Code |
761T2009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.97 |
| Max. Negotiated Rate |
$1,526.88 |
| Rate for Payer: Aetna Commercial |
$1,224.68
|
| Rate for Payer: Anthem Medicaid |
$546.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$795.25
|
| Rate for Payer: Cash Price |
$795.25
|
| Rate for Payer: Cigna Commercial |
$1,320.12
|
| Rate for Payer: First Health Commercial |
$1,510.97
|
| Rate for Payer: Humana Commercial |
$1,351.92
|
| Rate for Payer: Humana KY Medicaid |
$546.97
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$552.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,304.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.44
|
| Rate for Payer: PHCS Commercial |
$1,526.88
|
| Rate for Payer: United Healthcare All Payer |
$1,399.64
|
|
|
REPLACEMENT AORTIC VALVE
|
Professional
|
Both
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.00 |
| Max. Negotiated Rate |
$3,946.45 |
| Rate for Payer: Aetna Commercial |
$3,946.45
|
| Rate for Payer: Ambetter Exchange |
$2,131.29
|
| Rate for Payer: Anthem Medicaid |
$1,782.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,131.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,131.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,557.55
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,759.68
|
| Rate for Payer: Healthspan PPO |
$3,880.13
|
| Rate for Payer: Humana Medicaid |
$1,782.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,244.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,131.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,818.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,782.46
|
| Rate for Payer: Multiplan PHCS |
$2,820.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,770.68
|
| Rate for Payer: UHCCP Medicaid |
$1,645.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,800.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,131.29
|
|
|
REPLACEMENT AORTIC VALVE
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS 33405
|
| Hospital Charge Code |
76101285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
