|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
76102340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$4,448.61 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,177.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,448.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,289.73
|
| 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 |
$3,177.58
|
| 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 |
$3,813.10
|
| 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/RMV PN/GASTR STIMUL(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
761P2340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$224.31
|
| Rate for Payer: Ambetter Exchange |
$217.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.54
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$217.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.11
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$222.46
|
| Rate for Payer: Healthspan PPO |
$384.57
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$217.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.87
|
| Rate for Payer: UHCCP Medicaid |
$67.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.59
|
|
|
REVISE SPERMATIC CORD VEINS
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.05 |
| Max. Negotiated Rate |
$571.94 |
| Rate for Payer: Aetna Commercial |
$571.94
|
| Rate for Payer: Ambetter Exchange |
$334.07
|
| Rate for Payer: Anthem Medicaid |
$313.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$334.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$334.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$400.88
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$509.76
|
| Rate for Payer: Healthspan PPO |
$553.78
|
| Rate for Payer: Humana Medicaid |
$313.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$481.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$334.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.26
|
| Rate for Payer: Molina Healthcare Passport |
$313.98
|
| Rate for Payer: Multiplan PHCS |
$517.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.29
|
| Rate for Payer: UHCCP Medicaid |
$302.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$334.07
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.79 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem Medicaid |
$296.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Humana KY Medicaid |
$296.79
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$299.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$750.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.47
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.90 |
| Max. Negotiated Rate |
$828.48 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$750.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.47
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
|
REVISE SPINE ELTRD PERQ ARA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
761P2307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$786.31
|
| Rate for Payer: Ambetter Exchange |
$426.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.44
|
| Rate for Payer: Anthem Medicaid |
$580.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$426.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.28
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$768.67
|
| Rate for Payer: Healthspan PPO |
$808.92
|
| Rate for Payer: Humana Medicaid |
$580.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$426.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$592.00
|
| Rate for Payer: Molina Healthcare Passport |
$580.39
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$554.97
|
| Rate for Payer: UHCCP Medicaid |
$240.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$586.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$426.90
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$786.31
|
| Rate for Payer: Ambetter Exchange |
$426.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.44
|
| Rate for Payer: Anthem Medicaid |
$580.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$426.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.28
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$768.67
|
| Rate for Payer: Healthspan PPO |
$808.92
|
| Rate for Payer: Humana Medicaid |
$580.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$426.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$592.00
|
| Rate for Payer: Molina Healthcare Passport |
$580.39
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$554.97
|
| Rate for Payer: UHCCP Medicaid |
$240.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$586.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$426.90
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,320.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.42
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Ambetter Exchange |
$574.76
|
| Rate for Payer: Anthem Medicaid |
$368.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$574.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$574.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$689.71
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$801.99
|
| Rate for Payer: Healthspan PPO |
$687.93
|
| Rate for Payer: Humana Medicaid |
$368.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$737.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$574.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.87
|
| Rate for Payer: Molina Healthcare Passport |
$368.50
|
| Rate for Payer: Multiplan PHCS |
$910.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$747.19
|
| Rate for Payer: UHCCP Medicaid |
$531.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$574.76
|
|
|
REVISE ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
76102362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.04 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem Medicaid |
$522.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| 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 |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Humana KY Medicaid |
$522.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$527.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,320.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.42
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
REVISE ULNAR NERVE AT ELBOW(P
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
761P2362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Ambetter Exchange |
$574.76
|
| Rate for Payer: Anthem Medicaid |
$368.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$574.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$574.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$689.71
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$801.99
|
| Rate for Payer: Healthspan PPO |
$687.93
|
| Rate for Payer: Humana Medicaid |
$368.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$737.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$574.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.87
|
| Rate for Payer: Molina Healthcare Passport |
$368.50
|
| Rate for Payer: Multiplan PHCS |
$910.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$747.19
|
| Rate for Payer: UHCCP Medicaid |
$531.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$574.76
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.11 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$882.42
|
| Rate for Payer: Anthem Medicaid |
$394.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$893.88
|
| 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 |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$951.18
|
| Rate for Payer: First Health Commercial |
$1,088.70
|
| Rate for Payer: Humana Commercial |
$974.10
|
| Rate for Payer: Humana KY Medicaid |
$394.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$398.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$939.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$845.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,008.48
|
| Rate for Payer: Ohio Health Group HMO |
$859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.74
|
| Rate for Payer: PHCS Commercial |
$1,100.16
|
| Rate for Payer: United Healthcare All Payer |
$1,008.48
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Facility
|
IP
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,100.16 |
| Rate for Payer: Aetna Commercial |
$882.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$893.88
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$951.18
|
| Rate for Payer: First Health Commercial |
$1,088.70
|
| Rate for Payer: Humana Commercial |
$974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$939.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$845.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,008.48
|
| Rate for Payer: Ohio Health Group HMO |
$859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.74
|
| Rate for Payer: PHCS Commercial |
$1,100.16
|
| Rate for Payer: United Healthcare All Payer |
$1,008.48
|
|
|
REVISE ULNAR NERVE AT WRIST
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
76102363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.92 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Aetna Commercial |
$612.69
|
| Rate for Payer: Ambetter Exchange |
$388.47
|
| Rate for Payer: Anthem Medicaid |
$291.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$388.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$466.16
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$572.09
|
| Rate for Payer: Healthspan PPO |
$478.36
|
| Rate for Payer: Humana Medicaid |
$291.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.76
|
| Rate for Payer: Molina Healthcare Passport |
$291.92
|
| Rate for Payer: Multiplan PHCS |
$687.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$505.01
|
| Rate for Payer: UHCCP Medicaid |
$401.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$388.47
|
|
|
REVISE ULNAR NERVE AT WRIST(P
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 64719
|
| Hospital Charge Code |
761P2363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.92 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Aetna Commercial |
$612.69
|
| Rate for Payer: Ambetter Exchange |
$388.47
|
| Rate for Payer: Anthem Medicaid |
$291.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$388.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$466.16
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$572.09
|
| Rate for Payer: Healthspan PPO |
$478.36
|
| Rate for Payer: Humana Medicaid |
$291.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$388.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.76
|
| Rate for Payer: Molina Healthcare Passport |
$291.92
|
| Rate for Payer: Multiplan PHCS |
$687.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$505.01
|
| Rate for Payer: UHCCP Medicaid |
$401.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$388.47
|
|
|
REVISE URETHRA STAGE 1
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$1,302.35 |
| Rate for Payer: Aetna Commercial |
$1,302.35
|
| Rate for Payer: Ambetter Exchange |
$758.05
|
| Rate for Payer: Anthem Medicaid |
$564.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$758.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$758.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.66
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$1,161.05
|
| Rate for Payer: Healthspan PPO |
$1,041.34
|
| Rate for Payer: Humana Medicaid |
$564.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,092.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$758.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$758.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.09
|
| Rate for Payer: Molina Healthcare Passport |
$564.79
|
| Rate for Payer: Multiplan PHCS |
$492.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$985.47
|
| Rate for Payer: UHCCP Medicaid |
$287.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$758.05
|
|
|
REVISE URETHRA STAGE 1
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
REVISE URETHRA STAGE 1
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
HCPCS 53400
|
| Hospital Charge Code |
76102805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$631.40
|
| Rate for Payer: Anthem Medicaid |
$282.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$639.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna Commercial |
$680.60
|
| Rate for Payer: First Health Commercial |
$779.00
|
| Rate for Payer: Humana Commercial |
$697.00
|
| Rate for Payer: Humana KY Medicaid |
$282.00
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$284.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$672.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$605.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$287.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$721.60
|
| Rate for Payer: Ohio Health Group HMO |
$615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.80
|
| Rate for Payer: PHCS Commercial |
$787.20
|
| Rate for Payer: United Healthcare All Payer |
$721.60
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.90 |
| Max. Negotiated Rate |
$746.03 |
| Rate for Payer: Aetna Commercial |
$746.03
|
| Rate for Payer: Ambetter Exchange |
$473.43
|
| Rate for Payer: Anthem Medicaid |
$357.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$473.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$473.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$568.12
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$719.55
|
| Rate for Payer: Healthspan PPO |
$722.35
|
| Rate for Payer: Humana Medicaid |
$357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$625.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$473.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.06
|
| Rate for Payer: Molina Healthcare Passport |
$357.90
|
| Rate for Payer: Multiplan PHCS |
$742.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$615.46
|
| Rate for Payer: UHCCP Medicaid |
$433.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$473.43
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem Medicaid |
$425.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Humana KY Medicaid |
$425.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$430.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.22
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
|
REVISE VAG GRAFT VIA VAGINA
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
HCPCS 57295
|
| Hospital Charge Code |
76102906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.40 |
| Max. Negotiated Rate |
$1,188.48 |
| Rate for Payer: Aetna Commercial |
$953.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$965.64
|
| Rate for Payer: Cash Price |
$619.00
|
| Rate for Payer: Cigna Commercial |
$1,027.54
|
| Rate for Payer: First Health Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial |
$1,052.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,089.44
|
| Rate for Payer: Ohio Health Group HMO |
$928.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.22
|
| Rate for Payer: PHCS Commercial |
$1,188.48
|
| Rate for Payer: United Healthcare All Payer |
$1,089.44
|
|
|
REVISE WRIST/FOREARM TENDON
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REVISE WRIST/FOREARM TENDON
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.08 |
| Max. Negotiated Rate |
$1,229.42 |
| Rate for Payer: Aetna Commercial |
$895.34
|
| Rate for Payer: Ambetter Exchange |
$542.15
|
| Rate for Payer: Anthem Medicaid |
$330.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$542.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$542.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$650.58
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,229.42
|
| Rate for Payer: Healthspan PPO |
$810.99
|
| Rate for Payer: Humana Medicaid |
$330.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$729.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$542.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$336.68
|
| Rate for Payer: Molina Healthcare Passport |
$330.08
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.79
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$542.15
|
|
