|
REVERSE CUP SZ 42 NEUTRAL
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 42 NEUTRAL
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE IT KIT PLUS
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
22200132
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Kentucky WC Medicaid |
$95.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
REVERSE IT KIT PLUS
|
Professional
|
Both
|
$275.00
|
|
| Hospital Charge Code |
22200132
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
REVERSE IT KIT PLUS
|
Facility
|
IP
|
$275.00
|
|
| Hospital Charge Code |
22200132
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
REVERSE SHOULDER SPACER
|
Facility
|
IP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
REVERSE SHOULDER SPACER
|
Facility
|
OP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem Medicaid |
$7,264.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Humana KY Medicaid |
$7,264.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,338.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,410.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
REVERS SUTURE CUP 36+2 R
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERS SUTURE CUP 36+2 R
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
76102361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
76102361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REVISE ARM/LEG NERVE
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
76102361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$750.69
|
| Rate for Payer: Ambetter Exchange |
$478.98
|
| Rate for Payer: Anthem Medicaid |
$394.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.78
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$673.31
|
| Rate for Payer: Healthspan PPO |
$586.12
|
| Rate for Payer: Humana Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.12
|
| Rate for Payer: Molina Healthcare Passport |
$394.24
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.67
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.98
|
|
|
REVISE ARM/LEG NERVE(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
761P2361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$750.69
|
| Rate for Payer: Ambetter Exchange |
$478.98
|
| Rate for Payer: Anthem Medicaid |
$394.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.78
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$673.31
|
| Rate for Payer: Healthspan PPO |
$586.12
|
| Rate for Payer: Humana Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.12
|
| Rate for Payer: Molina Healthcare Passport |
$394.24
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.67
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.98
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 26140
|
| Hospital Charge Code |
76100676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REVISE FINGER JOINT EACH
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 26140
|
| Hospital Charge Code |
76100676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REVISE FINGER JOINT EACH
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26140
|
| Hospital Charge Code |
76100676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$796.71 |
| Rate for Payer: Aetna Commercial |
$717.90
|
| Rate for Payer: Ambetter Exchange |
$486.36
|
| Rate for Payer: Anthem Medicaid |
$308.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$486.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$486.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$583.63
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$796.71
|
| Rate for Payer: Healthspan PPO |
$650.27
|
| Rate for Payer: Humana Medicaid |
$308.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$486.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$314.96
|
| Rate for Payer: Molina Healthcare Passport |
$308.78
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$632.27
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$311.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$486.36
|
|
|
REVISE FINGER JOINT EACH(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 26140
|
| Hospital Charge Code |
761P0676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$796.71 |
| Rate for Payer: Aetna Commercial |
$717.90
|
| Rate for Payer: Ambetter Exchange |
$486.36
|
| Rate for Payer: Anthem Medicaid |
$308.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$486.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$486.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$583.63
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$796.71
|
| Rate for Payer: Healthspan PPO |
$650.27
|
| Rate for Payer: Humana Medicaid |
$308.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$486.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$314.96
|
| Rate for Payer: Molina Healthcare Passport |
$308.78
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$632.27
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$311.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$486.36
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
OP
|
$4,392.33
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
76102359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,510.52 |
| Max. Negotiated Rate |
$4,216.64 |
| Rate for Payer: Aetna Commercial |
$3,382.09
|
| Rate for Payer: Anthem Medicaid |
$1,510.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$2,196.16
|
| Rate for Payer: Cash Price |
$2,196.16
|
| Rate for Payer: Cigna Commercial |
$3,645.63
|
| Rate for Payer: First Health Commercial |
$4,172.71
|
| Rate for Payer: Humana Commercial |
$3,733.48
|
| Rate for Payer: Humana KY Medicaid |
$1,510.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,525.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,540.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,513.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,821.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,030.71
|
| Rate for Payer: PHCS Commercial |
$4,216.64
|
| Rate for Payer: United Healthcare All Payer |
$3,865.25
|
|
|
REVISE FINGER/TOE NERVE
|
Professional
|
Both
|
$4,392.33
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
76102359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$2,635.40 |
| Rate for Payer: Aetna Commercial |
$711.11
|
| Rate for Payer: Ambetter Exchange |
$488.29
|
| Rate for Payer: Anthem Medicaid |
$248.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$488.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$488.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.95
|
| Rate for Payer: Cash Price |
$2,196.16
|
| Rate for Payer: Cash Price |
$2,196.16
|
| Rate for Payer: Cigna Commercial |
$617.69
|
| Rate for Payer: Healthspan PPO |
$555.21
|
| Rate for Payer: Humana Medicaid |
$248.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$610.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$488.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.12
|
| Rate for Payer: Molina Healthcare Passport |
$248.16
|
| Rate for Payer: Multiplan PHCS |
$2,635.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.78
|
| Rate for Payer: UHCCP Medicaid |
$1,537.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$488.29
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
IP
|
$4,392.33
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
76102359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,317.70 |
| Max. Negotiated Rate |
$4,216.64 |
| Rate for Payer: Aetna Commercial |
$3,382.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.02
|
| Rate for Payer: Cash Price |
$2,196.16
|
| Rate for Payer: Cigna Commercial |
$3,645.63
|
| Rate for Payer: First Health Commercial |
$4,172.71
|
| Rate for Payer: Humana Commercial |
$3,733.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,513.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,821.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,030.71
|
| Rate for Payer: PHCS Commercial |
$4,216.64
|
| Rate for Payer: United Healthcare All Payer |
$3,865.25
|
|
|
REVISE FINGER/TOE NERVE(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
761P2359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$711.11 |
| Rate for Payer: Aetna Commercial |
$711.11
|
| Rate for Payer: Ambetter Exchange |
$488.29
|
| Rate for Payer: Anthem Medicaid |
$248.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$488.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$488.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.95
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$617.69
|
| Rate for Payer: Healthspan PPO |
$555.21
|
| Rate for Payer: Humana Medicaid |
$248.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$610.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$488.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.12
|
| Rate for Payer: Molina Healthcare Passport |
$248.16
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.78
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$488.29
|
|
|
REVISE FINGER/TOE NERVE(T
|
Facility
|
OP
|
$3,592.33
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
761T2359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,235.40 |
| Max. Negotiated Rate |
$3,448.64 |
| Rate for Payer: Aetna Commercial |
$2,766.09
|
| Rate for Payer: Anthem Medicaid |
$1,235.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,802.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$1,796.16
|
| Rate for Payer: Cash Price |
$1,796.16
|
| Rate for Payer: Cigna Commercial |
$2,981.63
|
| Rate for Payer: First Health Commercial |
$3,412.71
|
| Rate for Payer: Humana Commercial |
$3,053.48
|
| Rate for Payer: Humana KY Medicaid |
$1,235.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,651.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,161.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,694.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,873.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,125.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,478.71
|
| Rate for Payer: PHCS Commercial |
$3,448.64
|
| Rate for Payer: United Healthcare All Payer |
$3,161.25
|
|
|
REVISE FINGER/TOE NERVE(T
|
Facility
|
IP
|
$3,592.33
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
761T2359
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,077.70 |
| Max. Negotiated Rate |
$3,448.64 |
| Rate for Payer: Aetna Commercial |
$2,766.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,802.02
|
| Rate for Payer: Cash Price |
$1,796.16
|
| Rate for Payer: Cigna Commercial |
$2,981.63
|
| Rate for Payer: First Health Commercial |
$3,412.71
|
| Rate for Payer: Humana Commercial |
$3,053.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,651.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,161.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,694.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,873.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,125.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,478.71
|
| Rate for Payer: PHCS Commercial |
$3,448.64
|
| Rate for Payer: United Healthcare All Payer |
$3,161.25
|
|
|
REVISE GRAFT W/NONAUTO GRAF(P
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 35883
|
| Hospital Charge Code |
761P1426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$2,128.31 |
| Rate for Payer: Aetna Commercial |
$2,128.31
|
| Rate for Payer: Ambetter Exchange |
$1,120.00
|
| Rate for Payer: Anthem Medicaid |
$972.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,120.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$2,065.16
|
| Rate for Payer: Healthspan PPO |
$2,092.55
|
| Rate for Payer: Humana Medicaid |
$972.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,655.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,120.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,120.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$992.00
|
| Rate for Payer: Molina Healthcare Passport |
$972.55
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,456.00
|
| Rate for Payer: UHCCP Medicaid |
$1,079.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$982.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,120.00
|
|
|
REVISE GRAFT W/NONAUTO GRAFT
|
Facility
|
OP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 35883
|
| Hospital Charge Code |
76101426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.93 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem Medicaid |
$1,060.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$2,560.55
|
| Rate for Payer: First Health Commercial |
$2,930.75
|
| Rate for Payer: Humana Commercial |
$2,622.25
|
| Rate for Payer: Humana KY Medicaid |
$1,060.93
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
