|
REVISE WRIST/FOREARM TENDON
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
76100602
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$725.00
|
| 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: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| 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 |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| 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(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
761P0602
|
|
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
|
|
|
REVISE WRIST JOINT
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$1,364.41 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Ambetter Exchange |
$806.40
|
| Rate for Payer: Anthem Medicaid |
$624.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$806.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$806.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$967.68
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,364.41
|
| Rate for Payer: Healthspan PPO |
$1,124.17
|
| Rate for Payer: Humana Medicaid |
$624.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,047.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$806.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.08
|
| Rate for Payer: Molina Healthcare Passport |
$624.59
|
| Rate for Payer: Multiplan PHCS |
$1,263.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,048.32
|
| Rate for Payer: UHCCP Medicaid |
$736.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$806.40
|
|
|
REVISE WRIST JOINT
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$2,020.80 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
REVISE WRIST JOINT
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
76100607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.91 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem Medicaid |
$723.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Humana KY Medicaid |
$723.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$731.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
REVISE WRIST JOINT(P
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 25332
|
| Hospital Charge Code |
761P0607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.59 |
| Max. Negotiated Rate |
$1,364.41 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Ambetter Exchange |
$806.40
|
| Rate for Payer: Anthem Medicaid |
$624.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$806.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$806.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$967.68
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,364.41
|
| Rate for Payer: Healthspan PPO |
$1,124.17
|
| Rate for Payer: Humana Medicaid |
$624.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,047.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$806.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$806.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$637.08
|
| Rate for Payer: Molina Healthcare Passport |
$624.59
|
| Rate for Payer: Multiplan PHCS |
$1,263.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,048.32
|
| Rate for Payer: UHCCP Medicaid |
$736.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$630.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$806.40
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Facility
|
OP
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
76101842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.60 |
| Max. Negotiated Rate |
$1,518.72 |
| Rate for Payer: Aetna Commercial |
$1,218.14
|
| Rate for Payer: Anthem Medicaid |
$544.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,233.96
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,313.06
|
| Rate for Payer: First Health Commercial |
$1,502.90
|
| Rate for Payer: Humana Commercial |
$1,344.70
|
| Rate for Payer: Humana KY Medicaid |
$544.05
|
| Rate for Payer: Kentucky WC Medicaid |
$549.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,376.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.58
|
| Rate for Payer: PHCS Commercial |
$1,518.72
|
| Rate for Payer: United Healthcare All Payer |
$1,392.16
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
76101842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,688.29 |
| Rate for Payer: Aetna Commercial |
$1,688.29
|
| Rate for Payer: Ambetter Exchange |
$1,122.71
|
| Rate for Payer: Anthem Medicaid |
$538.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,122.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,122.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,347.25
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,564.20
|
| Rate for Payer: Healthspan PPO |
$1,423.76
|
| Rate for Payer: Humana Medicaid |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,502.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,122.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.26
|
| Rate for Payer: Molina Healthcare Passport |
$538.49
|
| Rate for Payer: Multiplan PHCS |
$949.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,459.52
|
| Rate for Payer: UHCCP Medicaid |
$553.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$543.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,122.71
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Facility
|
IP
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
76101842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.60 |
| Max. Negotiated Rate |
$1,518.72 |
| Rate for Payer: Aetna Commercial |
$1,218.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,233.96
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,313.06
|
| Rate for Payer: First Health Commercial |
$1,502.90
|
| Rate for Payer: Humana Commercial |
$1,344.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,376.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.58
|
| Rate for Payer: PHCS Commercial |
$1,518.72
|
| Rate for Payer: United Healthcare All Payer |
$1,392.16
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
761P1842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,688.29 |
| Rate for Payer: Aetna Commercial |
$1,688.29
|
| Rate for Payer: Ambetter Exchange |
$1,122.71
|
| Rate for Payer: Anthem Medicaid |
$538.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,122.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,122.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,347.25
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,564.20
|
| Rate for Payer: Healthspan PPO |
$1,423.76
|
| Rate for Payer: Humana Medicaid |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,502.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,122.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.26
|
| Rate for Payer: Molina Healthcare Passport |
$538.49
|
| Rate for Payer: Multiplan PHCS |
$949.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,459.52
|
| Rate for Payer: UHCCP Medicaid |
$553.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$543.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,122.71
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
REVISION MASTOIDECTOMY
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
REVISION MASTOIDECTOMY
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.65 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,609.06
|
| Rate for Payer: Ambetter Exchange |
$1,030.58
|
| Rate for Payer: Anthem Medicaid |
$931.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,030.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,236.70
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,581.25
|
| Rate for Payer: Healthspan PPO |
$1,427.31
|
| Rate for Payer: Humana Medicaid |
$931.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,030.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.28
|
| Rate for Payer: Molina Healthcare Passport |
$931.65
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,339.75
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$940.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,030.58
|
|
|
REVISION MASTOIDECTOMY
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.92 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
REVISION MASTOIDECTOMY(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
761P2427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.65 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,609.06
|
| Rate for Payer: Ambetter Exchange |
$1,030.58
|
| Rate for Payer: Anthem Medicaid |
$931.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,030.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,236.70
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,581.25
|
| Rate for Payer: Healthspan PPO |
$1,427.31
|
| Rate for Payer: Humana Medicaid |
$931.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,030.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.28
|
| Rate for Payer: Molina Healthcare Passport |
$931.65
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,339.75
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$940.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,030.58
|
|
|
REVISION OF ARM TENDON
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REVISION OF ARM TENDON
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.63 |
| Max. Negotiated Rate |
$759.23 |
| Rate for Payer: Aetna Commercial |
$686.18
|
| Rate for Payer: Ambetter Exchange |
$450.62
|
| Rate for Payer: Anthem Medicaid |
$258.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$450.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$540.74
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$759.23
|
| Rate for Payer: Healthspan PPO |
$621.53
|
| Rate for Payer: Humana Medicaid |
$258.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$450.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.80
|
| Rate for Payer: Molina Healthcare Passport |
$258.63
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.81
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$450.62
|
|
|
REVISION OF ARM TENDON
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REVISION OF ARM TENDON(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
761P0518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.63 |
| Max. Negotiated Rate |
$759.23 |
| Rate for Payer: Aetna Commercial |
$686.18
|
| Rate for Payer: Ambetter Exchange |
$450.62
|
| Rate for Payer: Anthem Medicaid |
$258.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$450.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$540.74
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$759.23
|
| Rate for Payer: Healthspan PPO |
$621.53
|
| Rate for Payer: Humana Medicaid |
$258.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$450.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.80
|
| Rate for Payer: Molina Healthcare Passport |
$258.63
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.81
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$450.62
|
|
|
REVISION OF BIG TOE
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$549.77
|
| Rate for Payer: Ambetter Exchange |
$348.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$270.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.67
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$593.93
|
| Rate for Payer: Healthspan PPO |
$669.10
|
| Rate for Payer: Humana Medicaid |
$270.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$439.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$348.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.94
|
| Rate for Payer: Molina Healthcare Passport |
$270.53
|
| Rate for Payer: Multiplan PHCS |
$858.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.56
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.89
|
|
|
REVISION OF BIG TOE
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$491.78 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,101.10
|
| Rate for Payer: Anthem Medicaid |
$491.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,115.40
|
| 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 |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$1,186.90
|
| Rate for Payer: First Health Commercial |
$1,358.50
|
| Rate for Payer: Humana Commercial |
$1,215.50
|
| Rate for Payer: Humana KY Medicaid |
$491.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$496.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,172.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$501.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,258.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.70
|
| Rate for Payer: PHCS Commercial |
$1,372.80
|
| Rate for Payer: United Healthcare All Payer |
$1,258.40
|
|
|
REVISION OF BIG TOE
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$1,372.80 |
| Rate for Payer: Aetna Commercial |
$1,101.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,115.40
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$1,186.90
|
| Rate for Payer: First Health Commercial |
$1,358.50
|
| Rate for Payer: Humana Commercial |
$1,215.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,172.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,258.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.70
|
| Rate for Payer: PHCS Commercial |
$1,372.80
|
| Rate for Payer: United Healthcare All Payer |
$1,258.40
|
|
|
REVISION OF BIG TOE(P
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
761P1008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Aetna Commercial |
$549.77
|
| Rate for Payer: Ambetter Exchange |
$348.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$270.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.67
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$593.93
|
| Rate for Payer: Healthspan PPO |
$669.10
|
| Rate for Payer: Humana Medicaid |
$270.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$439.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$348.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.94
|
| Rate for Payer: Molina Healthcare Passport |
$270.53
|
| Rate for Payer: Multiplan PHCS |
$858.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.56
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.89
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
76102112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.06 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem Medicaid |
$490.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| 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 |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Humana KY Medicaid |
$490.06
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$495.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.25
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
76102112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.25
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
