|
SUTR LG INT 1/MULT PERF W/CO(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44605
|
| Hospital Charge Code |
761P1857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$708.57 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,889.38
|
| Rate for Payer: Anthem Medicaid |
$708.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,767.81
|
| Rate for Payer: Healthspan PPO |
$1,593.35
|
| Rate for Payer: Humana Medicaid |
$708.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,671.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.74
|
| Rate for Payer: Molina Healthcare Passport |
$708.57
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.66
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
761P2375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.58 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,280.24
|
| Rate for Payer: Anthem Medicaid |
$516.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,175.20
|
| Rate for Payer: Healthspan PPO |
$999.58
|
| Rate for Payer: Humana Medicaid |
$516.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,035.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.91
|
| Rate for Payer: Molina Healthcare Passport |
$516.58
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.75
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,760.51
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.58 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,280.24
|
| Rate for Payer: Anthem Medicaid |
$516.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,175.20
|
| Rate for Payer: Healthspan PPO |
$999.58
|
| Rate for Payer: Humana Medicaid |
$516.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,035.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.91
|
| Rate for Payer: Molina Healthcare Passport |
$516.58
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.75
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,283.11
|
| Rate for Payer: Anthem Medicaid |
$492.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,183.92
|
| Rate for Payer: Healthspan PPO |
$1,001.82
|
| Rate for Payer: Humana Medicaid |
$492.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,034.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$501.95
|
| Rate for Payer: Molina Healthcare Passport |
$492.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.03
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| 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 |
$5,760.51
|
| 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 |
$6,912.61
|
| 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 |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| 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 |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
761P2374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,283.11
|
| Rate for Payer: Anthem Medicaid |
$492.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,183.92
|
| Rate for Payer: Healthspan PPO |
$1,001.82
|
| Rate for Payer: Humana Medicaid |
$492.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,034.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$501.95
|
| Rate for Payer: Molina Healthcare Passport |
$492.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.03
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE COMPLEX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,612.71
|
| Rate for Payer: Anthem Medicaid |
$631.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,475.87
|
| Rate for Payer: Healthspan PPO |
$1,259.16
|
| Rate for Payer: Humana Medicaid |
$631.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.21
|
| Rate for Payer: Molina Healthcare Passport |
$631.58
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.90
|
|
|
SUTURE COMPLEX
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE COMPLEX
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SUTURE COMPLEX
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.44
|
| Rate for Payer: Humana Medicare Advantage |
$5,760.51
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SUTURE COMPLEX(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
761P2376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,612.71
|
| Rate for Payer: Anthem Medicaid |
$631.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,475.87
|
| Rate for Payer: Healthspan PPO |
$1,259.16
|
| Rate for Payer: Humana Medicaid |
$631.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.21
|
| Rate for Payer: Molina Healthcare Passport |
$631.58
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.90
|
|
|
SUTURE CUP 33MM +2LEFT
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
SUTURE CUP 33MM +2LEFT
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$5,760.51
|
| Rate for Payer: Kentucky WC Medicaid |
$373.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
761P2377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,376.59 |
| Rate for Payer: Aetna Commercial |
$1,376.59
|
| Rate for Payer: Anthem Medicaid |
$587.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,293.55
|
| Rate for Payer: Healthspan PPO |
$1,074.80
|
| Rate for Payer: Humana Medicaid |
$587.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$599.06
|
| Rate for Payer: Molina Healthcare Passport |
$587.31
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$593.18
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,376.59 |
| Rate for Payer: Aetna Commercial |
$1,376.59
|
| Rate for Payer: Anthem Medicaid |
$587.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,293.55
|
| Rate for Payer: Healthspan PPO |
$1,074.80
|
| Rate for Payer: Humana Medicaid |
$587.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$599.06
|
| Rate for Payer: Molina Healthcare Passport |
$587.31
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$593.18
|
|
|
SUTURELASSO SD WIRE LOOP
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
SUTURELASSO SD WIRE LOOP
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
