|
REVISE GRAFT W/NONAUTO GRAFT
|
Facility
|
IP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 35883
|
| Hospital Charge Code |
76101426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.50 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| 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: 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 |
$925.50
|
| 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
|
|
|
REVISE GRAFT W/NONAUTO GRAFT
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 35883
|
| Hospital Charge Code |
76101426
|
|
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/VEIN
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 35881
|
| Hospital Charge Code |
76102910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.37 |
| Max. Negotiated Rate |
$1,816.68 |
| Rate for Payer: Aetna Commercial |
$1,816.68
|
| Rate for Payer: Ambetter Exchange |
$959.66
|
| Rate for Payer: Anthem Medicaid |
$798.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$959.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$959.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,151.59
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cigna Commercial |
$1,756.98
|
| Rate for Payer: Healthspan PPO |
$1,786.16
|
| Rate for Payer: Humana Medicaid |
$798.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$959.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$814.34
|
| Rate for Payer: Molina Healthcare Passport |
$798.37
|
| Rate for Payer: Multiplan PHCS |
$1,507.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,247.56
|
| Rate for Payer: UHCCP Medicaid |
$879.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$806.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$959.66
|
|
|
REVISE GRAFT W/VEIN
|
Facility
|
IP
|
$2,513.00
|
|
|
Service Code
|
HCPCS 35881
|
| Hospital Charge Code |
76102910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$753.90 |
| Max. Negotiated Rate |
$2,412.48 |
| Rate for Payer: Aetna Commercial |
$1,935.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,960.14
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cigna Commercial |
$2,085.79
|
| Rate for Payer: First Health Commercial |
$2,387.35
|
| Rate for Payer: Humana Commercial |
$2,136.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,060.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$753.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,211.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,884.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,010.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,186.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.97
|
| Rate for Payer: PHCS Commercial |
$2,412.48
|
| Rate for Payer: United Healthcare All Payer |
$2,211.44
|
|
|
REVISE GRAFT W/VEIN
|
Facility
|
OP
|
$2,513.00
|
|
|
Service Code
|
HCPCS 35881
|
| Hospital Charge Code |
76102910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.22 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,935.01
|
| Rate for Payer: Anthem Medicaid |
$864.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,960.14
|
| 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 |
$1,256.50
|
| Rate for Payer: Cash Price |
$1,256.50
|
| Rate for Payer: Cigna Commercial |
$2,085.79
|
| Rate for Payer: First Health Commercial |
$2,387.35
|
| Rate for Payer: Humana Commercial |
$2,136.05
|
| Rate for Payer: Humana KY Medicaid |
$864.22
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$873.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,060.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,854.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$881.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,211.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,884.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,010.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,186.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.97
|
| Rate for Payer: PHCS Commercial |
$2,412.48
|
| Rate for Payer: United Healthcare All Payer |
$2,211.44
|
|
|
REVISE/IMPLANT FINGER JOINT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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/IMPLANT FINGER JOINT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
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/IMPLANT FINGER JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
76100714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$1,041.98 |
| Rate for Payer: Aetna Commercial |
$940.53
|
| Rate for Payer: Ambetter Exchange |
$692.69
|
| Rate for Payer: Anthem Medicaid |
$400.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.23
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,041.98
|
| Rate for Payer: Healthspan PPO |
$851.92
|
| Rate for Payer: Humana Medicaid |
$400.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.12
|
| Rate for Payer: Molina Healthcare Passport |
$400.12
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.50
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.69
|
|
|
REVISE/IMPLANT FINGER JOINT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 26536
|
| Hospital Charge Code |
761P0714
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$1,041.98 |
| Rate for Payer: Aetna Commercial |
$940.53
|
| Rate for Payer: Ambetter Exchange |
$692.69
|
| Rate for Payer: Anthem Medicaid |
$400.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.23
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,041.98
|
| Rate for Payer: Healthspan PPO |
$851.92
|
| Rate for Payer: Humana Medicaid |
$400.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.12
|
| Rate for Payer: Molina Healthcare Passport |
$400.12
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.50
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.69
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$984.93 |
| Rate for Payer: Aetna Commercial |
$893.50
|
| Rate for Payer: Ambetter Exchange |
$605.20
|
| Rate for Payer: Anthem Medicaid |
$427.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$605.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$605.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$726.24
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$984.93
|
| Rate for Payer: Healthspan PPO |
$809.32
|
| Rate for Payer: Humana Medicaid |
$427.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$605.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.02
|
| Rate for Payer: Molina Healthcare Passport |
$427.47
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$786.76
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$605.20
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REVISE KNUCKLE WITH IMPLANT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
76100713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REVISE KNUCKLE WITH IMPLANT(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
761P0713
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.47 |
| Max. Negotiated Rate |
$984.93 |
| Rate for Payer: Aetna Commercial |
$893.50
|
| Rate for Payer: Ambetter Exchange |
$605.20
|
| Rate for Payer: Anthem Medicaid |
$427.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$605.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$605.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$726.24
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$984.93
|
| Rate for Payer: Healthspan PPO |
$809.32
|
| Rate for Payer: Humana Medicaid |
$427.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$605.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.02
|
| Rate for Payer: Molina Healthcare Passport |
$427.47
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$786.76
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$431.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$605.20
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Facility
|
IP
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,297.50 |
| Max. Negotiated Rate |
$4,152.00 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,762.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.25
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Professional
|
Both
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,420.54 |
| Max. Negotiated Rate |
$3,417.13 |
| Rate for Payer: Ambetter Exchange |
$1,674.56
|
| Rate for Payer: Anthem Medicaid |
$1,420.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,674.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,674.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,009.47
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,417.13
|
| Rate for Payer: Healthspan PPO |
$1,893.35
|
| Rate for Payer: Humana Medicaid |
$1,420.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,292.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,674.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,674.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,448.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,420.54
|
| Rate for Payer: Multiplan PHCS |
$2,595.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,176.93
|
| Rate for Payer: UHCCP Medicaid |
$1,513.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,434.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,674.56
|
|
|
REVIS ELBOW ARTH HUM&ULNA
|
Facility
|
OP
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,487.37 |
| Max. Negotiated Rate |
$23,788.86 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem Medicaid |
$1,487.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,992.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| 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 |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Humana KY Medicaid |
$1,487.37
|
| Rate for Payer: Humana Medicare Advantage |
$16,992.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,502.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,390.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,762.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.25
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Professional
|
Both
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.75 |
| Max. Negotiated Rate |
$2,964.42 |
| Rate for Payer: Ambetter Exchange |
$1,458.83
|
| Rate for Payer: Anthem Medicaid |
$1,232.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,458.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,458.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,750.60
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,964.42
|
| Rate for Payer: Healthspan PPO |
$1,641.69
|
| Rate for Payer: Humana Medicaid |
$1,232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,458.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,256.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,232.05
|
| Rate for Payer: Multiplan PHCS |
$2,055.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,896.48
|
| Rate for Payer: UHCCP Medicaid |
$1,198.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,244.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,458.83
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
REVIS ELBOW ARTH HUM/ULNA
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
76100528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,177.86 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
REVIS ELBOW ARTH HUM&ULNA(P
|
Professional
|
Both
|
$4,325.00
|
|
|
Service Code
|
HCPCS 24371
|
| Hospital Charge Code |
761P0529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,420.54 |
| Max. Negotiated Rate |
$3,417.13 |
| Rate for Payer: Ambetter Exchange |
$1,674.56
|
| Rate for Payer: Anthem Medicaid |
$1,420.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,674.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,674.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,009.47
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,417.13
|
| Rate for Payer: Healthspan PPO |
$1,893.35
|
| Rate for Payer: Humana Medicaid |
$1,420.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,292.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,674.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,674.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,448.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,420.54
|
| Rate for Payer: Multiplan PHCS |
$2,595.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,176.93
|
| Rate for Payer: UHCCP Medicaid |
$1,513.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,434.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,674.56
|
|
|
REVIS ELBOW ARTH HUM/ULNA (P
|
Professional
|
Both
|
$3,425.00
|
|
|
Service Code
|
HCPCS 24370
|
| Hospital Charge Code |
761P0528
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,198.75 |
| Max. Negotiated Rate |
$2,964.42 |
| Rate for Payer: Ambetter Exchange |
$1,458.83
|
| Rate for Payer: Anthem Medicaid |
$1,232.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,458.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,458.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,750.60
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,964.42
|
| Rate for Payer: Healthspan PPO |
$1,641.69
|
| Rate for Payer: Humana Medicaid |
$1,232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,458.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,256.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,232.05
|
| Rate for Payer: Multiplan PHCS |
$2,055.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,896.48
|
| Rate for Payer: UHCCP Medicaid |
$1,198.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,244.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,458.83
|
|
|
REVISE LOWER LEG TENDON
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 27691
|
| Hospital Charge Code |
76102682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$1,190.57 |
| Rate for Payer: Aetna Commercial |
$1,110.52
|
| Rate for Payer: Ambetter Exchange |
$706.83
|
| Rate for Payer: Anthem Medicaid |
$512.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$706.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$706.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.20
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,190.57
|
| Rate for Payer: Healthspan PPO |
$1,005.89
|
| Rate for Payer: Humana Medicaid |
$512.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$706.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$706.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.20
|
| Rate for Payer: Molina Healthcare Passport |
$512.94
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$918.88
|
| Rate for Payer: UHCCP Medicaid |
$330.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$706.83
|
|
|
REVISE LOWER LEG TENDON
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.55 |
| Max. Negotiated Rate |
$1,006.51 |
| Rate for Payer: Aetna Commercial |
$944.82
|
| Rate for Payer: Ambetter Exchange |
$607.96
|
| Rate for Payer: Anthem Medicaid |
$439.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$607.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$729.55
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,006.51
|
| Rate for Payer: Healthspan PPO |
$855.80
|
| Rate for Payer: Humana Medicaid |
$439.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$607.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.34
|
| Rate for Payer: Molina Healthcare Passport |
$439.55
|
| Rate for Payer: Multiplan PHCS |
$937.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$790.35
|
| Rate for Payer: UHCCP Medicaid |
$547.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$443.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$607.96
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.90 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,359.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.47
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
REVISE LOWER LEG TENDON
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 27690
|
| Hospital Charge Code |
76102880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.52 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem Medicaid |
$537.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Humana KY Medicaid |
$537.52
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$542.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,359.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.47
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
